<div class="contactform" style="margin:0em;width:310px;"> 
	<form method="post" action="login/register"> 
		<fieldset>
			<legend>&nbsp;Registrar Nuevo Usuario&nbsp;</legend> 
			<p>
				<label for="surname" class="left" style="width:90px;">Apellido:</label> 
				<input type="text" name="surname" id="surname" class="field" style="width:180px;" value="" tabindex="1" />
			</p> 
			<p>
				<label for="firstname" class="left" style="width:90px;">Nombre:</label> 
				<input type="text" name="firstname" id="firstname" class="field" style="width:180px;" value="" tabindex="1" />
			</p>
			<p>
				<label for="email" class="left" style="width:90px;">Email:</label> 
				<input type="text" name="email" id="email" class="field" style="width:180px;" value="" tabindex="2" />
			</p> 
			<p>
				<label for="username" class="left" style="width:90px;">Usuario:</label> 
				<input type="text" name="username" id="username" class="field" style="width:180px;" value="" tabindex="1" />
			</p> 
			<p>
				<label for="password" class="left" style="width:90px;">Contrase&ntilde;a:</label> 
				<input type="password" name="password" id="password" class="field" style="width:180px;" value="" tabindex="1" />
			</p> 
			<p>
				<label for="password_confirm" class="left" style="width:90px;">Confirmar Contrase&ntilde;a:</label> 
				<input type="password" name="password_confirm" id="password_confirm" class="field" style="width:180px;" value="" tabindex="1" />
			</p>
			<p>
				<input type="submit" name="submit" id="submit" class="button" value="Registrar" tabindex="6" />
			</p> 
		</fieldset> 
	</form> 
</div>              
